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Patient characteristics in relation to opioid exposure in a chronic non-cancer pain population

Grelz, Henrik LU orcid ; Jakobsson, Ulf LU orcid ; Midlöv, Patrik LU orcid ; Fischer, Marcelo Rivano LU and Ringqvist, Åsa LU (2024) In Scandinavian Journal of Pain 24(1).
Abstract

OBJECTIVES: The efficacy of long-term opioid therapy (LTOT) in treating patients with chronic non-cancer pain (CnCP) is questionable, and the potential risks of adverse effects are well established. The aims were as follows: (1) compare characteristics in patients exposed to LTOT vs non-exposed. (2) Regarding opioid-exposed patients, describe characteristics of patients with risk factors for opioid use disorder or overdose in relation to opioid dosage.

METHOD: A cross-sectional study was conducted at a Swedish tertiary pain rehabilitation clinic serving CnCP patients. The study population comprised 1,604 patients ≥18 years old registered in the Swedish Quality Registry for Pain Rehabilitation between 2018 and 2020. Data on... (More)

OBJECTIVES: The efficacy of long-term opioid therapy (LTOT) in treating patients with chronic non-cancer pain (CnCP) is questionable, and the potential risks of adverse effects are well established. The aims were as follows: (1) compare characteristics in patients exposed to LTOT vs non-exposed. (2) Regarding opioid-exposed patients, describe characteristics of patients with risk factors for opioid use disorder or overdose in relation to opioid dosage.

METHOD: A cross-sectional study was conducted at a Swedish tertiary pain rehabilitation clinic serving CnCP patients. The study population comprised 1,604 patients ≥18 years old registered in the Swedish Quality Registry for Pain Rehabilitation between 2018 and 2020. Data on dispensed opioids were extracted from the Swedish Prescribed Drug Register. Dependent variables were as follows: LTOT vs non-LTOT and exposed opioid dosage <50 mg morphine equivalent/day (MME/day) vs ≥50 MME/day.

RESULTS: Of the included patients, 681 (42.5%) had at least one dispensation of opioids 180 days prior to assessment, 601 with a calculated opioid dosage ≥1 MME/day, and 424 (26.4%) were exposed to LTOT. The type of opioid prescribed was, in descending order, oxycodone (42.3% of all dispensations), codeine in combination with paracetamol (17.6%), tramadol (13.8%), and morphine (8.1%). A total of 89 cases had dosages of ≥50 MME/day and 430 patient dosages <50 MME/day. Patients exposed to LTOT exhibited an increased odds ratio (OR) of 2.685 (95% CI, 1.942-3.711) for concomitant use of benzodiazepines and male sex (OR, 1.694; 95% CI, 1.227-2.337). Patients receiving doses ≥50 MME/day were all, except one, exposed to LTOT. The concomitant use of benzodiazepines (OR 1.814, 95% CI 1.264-3.331) and male sex (OR, 1.777; 95% CI, 1.178-3.102) indicated a higher OR for opioid doses ≥50 MME/day.

CONCLUSIONS: LTOT strongly influenced the opioid dose. Furthermore, concomitant benzodiazepine dispensation and male sex were over-represented in patients exposed to LTOT as well as those exposed to opioid doses ≥50 MME/day.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Male, Analgesics, Opioid/adverse effects, Female, Chronic Pain/drug therapy, Cross-Sectional Studies, Middle Aged, Sweden/epidemiology, Aged, Adult, Opioid-Related Disorders/epidemiology, Risk Factors
in
Scandinavian Journal of Pain
volume
24
issue
1
article number
20240025
publisher
De Gruyter
external identifiers
  • pmid:39714316
  • scopus:85213237196
ISSN
1877-8860
DOI
10.1515/sjpain-2024-0025
language
English
LU publication?
yes
id
90128a99-5005-4b09-8492-44f33c8802f2
date added to LUP
2024-12-30 05:51:38
date last changed
2025-07-10 02:12:53
@article{90128a99-5005-4b09-8492-44f33c8802f2,
  abstract     = {{<p>OBJECTIVES: The efficacy of long-term opioid therapy (LTOT) in treating patients with chronic non-cancer pain (CnCP) is questionable, and the potential risks of adverse effects are well established. The aims were as follows: (1) compare characteristics in patients exposed to LTOT vs non-exposed. (2) Regarding opioid-exposed patients, describe characteristics of patients with risk factors for opioid use disorder or overdose in relation to opioid dosage.</p><p>METHOD: A cross-sectional study was conducted at a Swedish tertiary pain rehabilitation clinic serving CnCP patients. The study population comprised 1,604 patients ≥18 years old registered in the Swedish Quality Registry for Pain Rehabilitation between 2018 and 2020. Data on dispensed opioids were extracted from the Swedish Prescribed Drug Register. Dependent variables were as follows: LTOT vs non-LTOT and exposed opioid dosage &lt;50 mg morphine equivalent/day (MME/day) vs ≥50 MME/day.</p><p>RESULTS: Of the included patients, 681 (42.5%) had at least one dispensation of opioids 180 days prior to assessment, 601 with a calculated opioid dosage ≥1 MME/day, and 424 (26.4%) were exposed to LTOT. The type of opioid prescribed was, in descending order, oxycodone (42.3% of all dispensations), codeine in combination with paracetamol (17.6%), tramadol (13.8%), and morphine (8.1%). A total of 89 cases had dosages of ≥50 MME/day and 430 patient dosages &lt;50 MME/day. Patients exposed to LTOT exhibited an increased odds ratio (OR) of 2.685 (95% CI, 1.942-3.711) for concomitant use of benzodiazepines and male sex (OR, 1.694; 95% CI, 1.227-2.337). Patients receiving doses ≥50 MME/day were all, except one, exposed to LTOT. The concomitant use of benzodiazepines (OR 1.814, 95% CI 1.264-3.331) and male sex (OR, 1.777; 95% CI, 1.178-3.102) indicated a higher OR for opioid doses ≥50 MME/day.</p><p>CONCLUSIONS: LTOT strongly influenced the opioid dose. Furthermore, concomitant benzodiazepine dispensation and male sex were over-represented in patients exposed to LTOT as well as those exposed to opioid doses ≥50 MME/day.</p>}},
  author       = {{Grelz, Henrik and Jakobsson, Ulf and Midlöv, Patrik and Fischer, Marcelo Rivano and Ringqvist, Åsa}},
  issn         = {{1877-8860}},
  keywords     = {{Humans; Male; Analgesics, Opioid/adverse effects; Female; Chronic Pain/drug therapy; Cross-Sectional Studies; Middle Aged; Sweden/epidemiology; Aged; Adult; Opioid-Related Disorders/epidemiology; Risk Factors}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  publisher    = {{De Gruyter}},
  series       = {{Scandinavian Journal of Pain}},
  title        = {{Patient characteristics in relation to opioid exposure in a chronic non-cancer pain population}},
  url          = {{http://dx.doi.org/10.1515/sjpain-2024-0025}},
  doi          = {{10.1515/sjpain-2024-0025}},
  volume       = {{24}},
  year         = {{2024}},
}